B-type Natriuretic Peptides in the Management of Acute Heart Failure and Acute Coronary Syndromes

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Asia Pacific Cardiology - Volume 1 Issue 1;2007:1(1):22-23


Acute coronary syndromes (ACS) and heart failure (HF) are both associated with complex neurohormonal activation. Commensurate with advances in pharmacological and device therapies for both conditions, the concept of using circulating biomarkers for diagnosis and risk stratification, as well as for targeting and monitoring therapy, has received great attention. Although many novel biomarkers have been identified and evaluated, few have been documented to provide clinically useful incremental information to existing risk markers.1 However, in patients with suspected acute HF, B-type natriuretic peptide (BNP) and N-terminal proBNP have been widely accepted as clinically useful tools. Moreover, among a large number of potential novel prognostic biomarkers in ACS, the BNPs have emerged as the strongest candidates for routine use as a supplement to cardiac-specific troponins.

Acute Heart Failure

The clinical diagnosis of HF can be challenging, particularly in patients presenting with acute shortness of breath in the urgent care setting. Information obtained from clinical history and physical examination, as well as from the electrocardiogram and chest radiograph, may provide valuable clues as to whether HF is the cause of symptoms, but additional diagnostic tests, including echocardiography, may be required to obtain a more definite diagnosis. Currently, the best documented and most widely used clinical application of BNP testing is for the emergency diagnosis of HF in patients presenting with acute dyspnoea. Following the publication of the results of The Breathing Not Properly Multinational study in 2002, BNP measurements have rapidly entered the clinical arena. This multicentre diagnostic test evaluation trial, which included 1,586 patients who visited the emergency department (ED) with a main complaint of acute dyspnoea, used a rapid point-of-care fluorescence immunoassay for BNP determination.2 Diagnosis of HF was adjudicated by cardiologists blinded to the BNP results. BNP levels were found to provide strong and incremental diagnostic information to conventional historical, clinical or other laboratory tests and to have greater diagnostic accuracy for the diagnosis of heart failure than the ED physician using all other available information. Importantly, BNP performed well in patients with an intermediate (20–80%) pre-test probability of HF as evaluated by the ED physician.3 In the subsequent N-terminal Pro-BNP Investigation of Dyspnea in the Emergency Department (PRIDE) study, similar results were published for NT-proBNP. This study included 599 patients presenting to the ED of Massachusetts General Hospital in Boston with acute dyspnoea.4


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